RT achieves excellent tumor control after subtotal resection of craniopharyngiomas.

A retrospective analysis of 16 patients with orbital lymphoma or pseudolymphoma from 1961-1984 was undertaken to evaluate the use of radiation therapy. Pathologic assessment confirmed that four patients had benign pseudolymphoma, and 12 patients had true malignant lymphoma, including two with advanced disease at presentation. With a median follow-up of 4 years, the local control rate with radiation therapy was 100%, although the two patients with advanced disease died of lymphoma 26-33 months after irradiation. While doses of 1,600-2,000 cGy appear adequate for pseudolymphoma, for lymphoma a dose of 3,000-4,000 cGy is necessary. Subconjunctival lesions can be treated in a single anteroposterior field; retroorbital lesions require an additional lateral field.

comparison of characteristics between the two groups. Survival estimates were calculated using the Kaplan-Meier method. Results: A total of 124 lesions (56 for CHRT and 68 for SBRT) were treated in 46 patients. Median follow-up was 32 months (28.5 for SBRT vs. 37.5 for CHRT; pZ0.11). Median age at treatment was 59.5 and 53 years for SBRT and CHRT, respectively (pZ0.04). SBRT-treated patients had higher rates of oligometastasis (72% vs. 52%, pZ0.02) and more had all of their known lesions treated (65% vs. 22%, p<0.0001). Most common regimens were 3000 cGy in 10 fractions (CHRT) and 5000 cGy in 5 fractions (SBRT). Treatment intent was curative for 66% in the SBRT group. More patients treated with CHRT received chemotherapy (55% vs. 27%, pZ0.002). However, more patients treated with SBRT received immunotherapy (70% vs. 41%, pZ0.005). LC was higher with SBRT (91% vs. 67%, pZ0.009), as was the complete response rate (81% vs. 13%, p<0.0001). Median PFS was 112 days for SBRT and 47 days for CHRT (pZ0.001). Six and 12-month PFS were 35% and 15% for SBRT and 9% and 7% for CHRT (pZ0.001). Median OS was higher after SBRT (22.9 months vs. 6.9 months, p<0.0001). One and 2-year OS were 71% and 49% for SBRT and 29% and 12% for CFRT (p<0.0001). On multivariate analysis, use of SBRT (HR 0.62, pZ0.0395) and treating all lesions (HR 0.41, pZ0.005) were associated with improved PFS. On multivariate analysis for OS, age >55 years (HR 2.35, pZ0.0008), use of SBRT (HR 0.35, pZ0.0003) and treating all lesions (HR 0.22, p<0.0001) were statistically significant. In contrast, systemic therapy (chemotherapy or immunotherapy) was not associated with improved PFS or OS on multivariate analyses. Conclusion: In summary, the superior LC achieved with SBRT for extracranial MM metastases is consistent with those observed with SRS for intracranial metastases, which implies that a high biological dose can overcome the radioresistance of MM histology. Our retrospective study suggests that SBRT treatment in a select cohort of oligometastatic MM patients can lead to improvement in PFS and OS, which is consistent with surgical literature.

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